Interim Guidance for Humanitarian Workers
November 29, 2005
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Travelers planning to conduct humanitarian work in areas where outbreaks of Ebola hemorrhagic fever and Marburg hemorrhagic fever are known to occur need to be familiar with how Ebola virus and Marburg virus are transmitted. These viruses are believed to be transmitted from an unknown animal host to humans. Humans can infect other humans through contact with blood or body fluids (e.g., saliva, urine). People who have close contact with a human or nonhuman primate infected with the virus are at risk. Such persons include laboratory or quarantine facility workers who handle nonhuman primates that have been associated with the disease. Hospital staff and family members who care for patients with the disease also are at risk if they do not use proper barrier nursing techniques. These precautions include wearing protective gowns, gloves, and masks, in addition to wearing eye protection (e.g., eye glasses) or a face shield.
The likelihood of contracting any viral hemorrhagic fever (VHF), including Ebola or Marburg, is considered extremely low unless there has been travel to the affected area and direct contact with the blood or body fluids (e.g., saliva, urine) of symptomatic infected persons or animals, or objects that have been contaminated with body fluids. The cause of fever in persons who have traveled in areas where VHF is present is more likely to be a common infectious disease, but such persons should be evaluated by a health-care provider to be sure.
Recommendations for Humanitarian Workers
If you travel to an area affected by a VHF outbreak, the following guidelines are recommended:
Before you leave
- Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer, household disinfectant, alcohol-based hand rubs for hand hygiene. In addition, you should include a supply of surgical masks and disposable gloves if your agency does not provide them and you may be in situations where you have close contact with persons suspected of having a VHF infection.
- Inform yourself and others who may be traveling with you about Ebola and Marburg virus. For information about these illnesses, see CDC's Ebola website and CDC's Marburg website.
- Be sure you are up to date with all your immunizations, and see your health-care provider at least 4-6 weeks before travel to get any additional immunizations, medications, or information you may need. For information on CDC health recommendations for international travel, see CDC's Travelers' Health site.
- You may wish to check your health insurance plan or get additional insurance that covers medical evacuation in the event of illness. Information about medical evacuation services can be found at this U.S. Department of State page.
- Identify in-country health-care resources in advance of your trip.
While you are in an area where Ebola or Marburg hemorrhagic fever has been reported
- Observe barrier techniques when in close contact with persons who have Ebola or Marburg hemorrhagic fever or persons and animals suspected of having Ebola or Marburg virus infection. These barrier techniques include wearing protective gowns, gloves, and masks in addition to eye protection (e.g., eye glasses) or face shields. Sterilization or proper disposal of needles and equipment, and proper disposal of patient excretions are also important to prevent the spread of infection.
- As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Cleaning your hands often, using soap and water (or waterless alcohol-based hand rubs when soap is not available), removes potentially infectious materials from your skin and helps prevent disease transmission.
- When wearing disposable gloves, wash the gloves with soap and water before removing them. Do not reuse the gloves; instead dispose of them according to recommended infection control precautions, see http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual/section6.htm. After disposing of the gloves, wash your hands again.
- Avoid contact with ill or dead animals, especially primates.
- Do not eat "bushmeat" (wild animals, including primates, sold for consumption as food in local markets).
If you think you have Ebola or Marburg virus infection or symptoms compatible with Ebola or Marburg hemorrhagic fever
If you or your family members become ill with fever or develop other symptoms such as chills, muscle aches, nausea, vomiting, or rash, visit a health-care provider immediately and inform them that you may have been in contact with someone with Marburg hemorrhagic fever. The nearest U.S. Embassy or Consular Office can help you find a provider in the area. You are encouraged to identify these resources in advance. When traveling to a health-care provider, limit your contact with others. All other travel should be avoided.
After your return
Persons returning from the affected area should monitor their health for 10 days. Any traveler who becomes ill, even if only a fever, should consult a health-care provider immediately and tell him or her about their recent travel and potential contacts. Tell the provider about your symptoms prior to going to the office or emergency room so arrangements can be made, if necessary, to prevent transmission to others in the health-care setting.
- For more information about CDC's health recommendations for travel to Central Africa, see: Travelers' Health - Central Africa - Region.
- For more information about Marburg hemorrhagic fever, see: Marburg Hemorrhagic Fever.
- For more information about Ebola hemorrhagic fever, see:Ebola Hemorrhagic Fever.
- For information about viral hemorrhagic fevers and precautionary measures, see: VHF Disease Information.
- For health-care workers who will be working with VHF patients in African healthcare settings, CDC in conjunction with the WHO has developed practical, hospital-based guidelines, entitled Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting.